Underdiagnosis of cervical intraepithelial neoplasia by colposcopy and its association with thin high‑grade squamous intraepithelial lesions

Li,Mingzhu; Zhang,Xiaobo; Zhang,Qisong; Zhao,Yun; Zhao,Chao; Li,Jingran; Tao,Hong; Shen,Danhua; Wei,Lihui

doi:10.3892/ol.2023.13873

July-2023 Volume 26 Issue 1

Full Size Image

Journals

International Journal of Molecular Medicine

International Journal of Molecular Medicine is an international journal devoted to molecular mechanisms of human disease.

International Journal of Oncology

International Journal of Oncology is an international journal devoted to oncology research and cancer treatment.

Molecular Medicine Reports

Covers molecular medicine topics such as pharmacology, pathology, genetics, neuroscience, infectious diseases, molecular cardiology, and molecular surgery.

Oncology Reports

Oncology Reports is an international journal devoted to fundamental and applied research in Oncology.

Experimental and Therapeutic Medicine

Experimental and Therapeutic Medicine is an international journal devoted to laboratory and clinical medicine.

Oncology Letters

Oncology Letters is an international journal devoted to Experimental and Clinical Oncology.

Biomedical Reports

Explores a wide range of biological and medical fields, including pharmacology, genetics, microbiology, neuroscience, and molecular cardiology.

Molecular and Clinical Oncology

International journal addressing all aspects of oncology research, from tumorigenesis and oncogenes to chemotherapy and metastasis.

World Academy of Sciences Journal

Multidisciplinary open-access journal spanning biochemistry, genetics, neuroscience, environmental health, and synthetic biology.

International Journal of Functional Nutrition

Open-access journal combining biochemistry, pharmacology, immunology, and genetics to advance health through functional nutrition.

International Journal of Epigenetics

Publishes open-access research on using epigenetics to advance understanding and treatment of human disease.

Medicine International

An International Open Access Journal Devoted to General Medicine.

July-2023 Volume 26 Issue 1

Full Size Image

Article Open Access

Underdiagnosis of cervical intraepithelial neoplasia by colposcopy and its association with thin high‑grade squamous intraepithelial lesions

Authors:
- Mingzhu Li
- Xiaobo Zhang
- Qisong Zhang
- Yun Zhao
- Chao Zhao
- Jingran Li
- Hong Tao
- Danhua Shen
- Lihui Wei
View Affiliations / Copyright

Affiliations: Department of Obstetrics and Gynecology, Peking University People's Hospital, Beijing 100044, P.R. China, Department of Pathology, Peking University People's Hospital, Beijing 100044, P.R. China, Hoomya Ltd., Changsha, Hunan 410017, P.R. China

Copyright: © Li et al. This is an open access article distributed under the terms of Creative Commons Attribution License.
Article Number: 287
|
Published online on: May 19, 2023

https://doi.org/10.3892/ol.2023.13873
Expand metrics +

Abstract

The relationship between the thickness of the epithelium and the colposcopic diagnosis is controversial. The present study was conducted to determine whether colposcopic underdiagnosis of cervical intraepithelial neoplasia (CIN) is associated with thin high‑grade squamous intraepithelial lesions (HSILs) of the cervix. A total of 136 cases of HSIL verified by pathological biopsy at Peking University People's Hospital between June and October 2021 were retrospectively analyzed; 79 cases were CIN2 and 57 cases were CIN3. The number and thickness of epithelial layers were analyzed using colposcopic impressions. In the low‑grade colposcopic impression group, the number of epithelial layers (12.8±4.2 vs. 17.8±4.2) and epithelial thickness (105.2±41.9 µm vs. 150.3±50.0 µm) of CIN2 lesions were significantly lower compared with the high‑grade colposcopic impression group; however, the differences for CIN3 were not statistically significant. CIN2 lesions had significantly fewer (12.8±4.2 vs. 17.2±5.4) and thinner (105.2±41.9 µm vs. 140.4±48.6 µm) epithelial layers than CIN3 lesions in the low‑grade colposcopic impression groups. In the high‑grade colposcopic impression group, however, there were no significant differences in the number or thickness of epithelial layers between CIN2 and CIN3. In 12 cases of thin HSILs, 91.6% of the colposcopic impressions were low‑grade. Thin HSILs are likely associated with underdiagnosed colposcopic findings, particularly for CIN2. Thin HSILs usually present with small to minute lesions and lack the typical colposcopic appearance of classic HSIL, which may help to explain why thin HSILs are easily underestimated under colposcopy.

View Figures

View References

1	Waxman AG, Chelmow D, Darragh TM, Lawson H and Moscicki AB: Revised terminology for cervical histopathology and its implications for management of high-grade squamous intraepithelial lesions of the cervix. Obstet Gynecol. 120:1465–1471. 2012. View Article : Google Scholar : PubMed/NCBI
2	Tainio K, Athanasiou A, Tikkinen KAO, Aaltonen R, Hernándes JC, Glazer-Livson S, Jakobsson M, Joronen K, Kiviharju M, Louvanto K, et al: Clinical course of untreated cervical intraepithelial neoplasia grade 2 under active surveillance: Systematic review and meta-analysis. BMJ. 360:k4992018. View Article : Google Scholar : PubMed/NCBI
3	Reid R and Scalzi P: Genital warts and cervical cancer. VII. An improved colposcopic index for differentiating benign papillomaviral infections from high-grade cervical intraepithelial neoplasia. Am J Obstet Gynecol. 153:611–618. 1985. View Article : Google Scholar : PubMed/NCBI
4	Ferris DG and Litaker MS; ALTS Group, : Prediction of cervical histologic results using an abbreviated Reid Colposcopic Index during ALTS. Am J Obstet Gynecol. 194:704–710. 2006. View Article : Google Scholar : PubMed/NCBI
5	Yang B, Pretorius RG, Belinson JL, Zhang X, Burchette R and Qiao YL: False negative colposcopy is associated with thinner cervical intraepithelial neoplasia 2 and 3. Gynecol Oncol. 110:32–36. 2008. View Article : Google Scholar : PubMed/NCBI
6	Ghosh I, Mittal S, Banerjee D, Chowdhury N and Basu P: Study of correlation of cervical epithelial thickness with the grade of colposcopic abnormality. Int J Gynecol Pathol. 35:269–274. 2016. View Article : Google Scholar : PubMed/NCBI
7	Stoler M, Bergeron C, Colgan TJ, Ferenczy AS, Herrington CS and Kim KR: Squamous Cell Tumours and Precursors. Kurman RJ, Carcangiu ML, Herrington CS and Young RH: WHO Classification of Tumours of Female Reproductive Organs. IARC; Lyon: pp. pp171812014
8	Wentzensen N, Massad LS, Mayeaux EJ Jr, Khan MJ, Waxman AG, Einstein MH, Conageski C, Schiffman MH, Gold MA, Apgar BS, et al: Evidence-Based consensus recommendations for colposcopy practice for cervical cancer prevention in the United States. J Low Genit Tract Dis. 21:216–222. 2017. View Article : Google Scholar : PubMed/NCBI
9	Brown BH and Tidy JA: The diagnostic accuracy of colposcopy-A review of research methodology and impact on the outcomes of quality assurance. Eur J Obstet Gynecol Reprod Biol. 240:182–186. 2019. View Article : Google Scholar : PubMed/NCBI
10	Wang AC, Wang LQ, Li J, Li MX, Tu LL, Zhang YX and Liu AJ: Artificial intelligence aided measurement of cervical squamous epithelial thickness and its correlation with cervical precancerous lesions. Zhonghua Bing Li Xue Za Zhi. 50:339–343. 2021.(In Chinese). PubMed/NCBI
11	Reich O and Regauer S: Two major pathways for development of high-grade squamous intraepithelial lesions of the cervix. Am J Surg Pathol. 38:1579–1580. 2014. View Article : Google Scholar : PubMed/NCBI
12	Regauer S, Reich O and Kashofer K: Cervical precancers originate from infected proliferating reserve cells: A Comparative histologic and genetic study of thin and thick high-grade squamous intraepithelial lesions. Am J Surg Pathol. 46:519–527. 2022. View Article : Google Scholar : PubMed/NCBI
13	Woodman CB, Collins SI and Young LS: The natural history of cervical HPV infection: Unresolved issues. Nat Rev Cancer. 7:11–22. 2007. View Article : Google Scholar : PubMed/NCBI
14	Reich O and Regauer S: Thin HSIL of the cervix: Detecting a variant of high-grade squamous intraepithelial lesions with a p16INK4a antibody. Int J Gynecol Pathol. 36:71–75. 2017. View Article : Google Scholar : PubMed/NCBI
15	Regauer S, Reich O and Kashofer K: Thin variant of high-grade squamous intraepithelial lesion-relationship with high-risk and possibly carcinogenic human papilloma virus subtypes and somatic cancer gene mutations. Histopathology. 75:405–412. 2019. View Article : Google Scholar : PubMed/NCBI
16	Regauer S and Reich O: CK17 and p16 expression patterns distinguish (atypical) immature squamous metaplasia from high-grade cervical intraepithelial neoplasia (CIN III). Histopathology. 50:629–635. 2007. View Article : Google Scholar : PubMed/NCBI
17	Barzon L, Militello V, Pagni S, Franchin E, Dal Bello F, Mengoli C and Palu G: Distribution of human papillomavirus types in the anogenital tract of females and males. J Med Virol. 82:1424–1430. 2010. View Article : Google Scholar : PubMed/NCBI

Journals

International Journal of Molecular Medicine

International Journal of Oncology

Molecular Medicine Reports

Oncology Reports

Experimental and Therapeutic Medicine

Oncology Letters

Biomedical Reports

Molecular and Clinical Oncology

World Academy of Sciences Journal

International Journal of Functional Nutrition

International Journal of Epigenetics

Medicine International

Underdiagnosis of cervical intraepithelial neoplasia by colposcopy and its association with thin high‑grade squamous intraepithelial lesions

This article is mentioned in:

Abstract

Figure 1

Figure 2

Figure 3

Related Articles